JACKIE JUDD: Good Day, and welcome to Health On The Hill. I’m Jackie Judd. President Obama is re-elected and we again have a divided Congress. What does that mean for the Affordable Care Act and what did we learn about how voters viewed the reform law? Here to decipher the meaning of the election are Mary Agnes Carey of Kaiser Health News and journalist Rich Cohen. Welcome to you both.

MARY AGNES CAREY: Thank you.

RICHARD E. COHEN: Thank you.

JACKIE JUDD: The Affordable Care Act—the reform law—obviously will continue to be the law of the land, but that’s not the end of the story. Mary Agnes, what do you think Republicans will look for? What might the strategy be to continue to pick at the law?

MARY AGNES CAREY: As we know in the current Congress they voted over 30 times to repeal either the entire law or pieces of that. I don’t think you’ll see that in the next Congress. I think what you’ll see is a lot of heavy oversight in every element of implementation—whether it is the exchanges or the Medicaid expansion or other parts of the health law that govern Medicare and other areas of the health system. They are going to make the case: these are the flaws that we see and perhaps those can be used as leverage in another negotiating deal. And also, let’s not forget we’ve just gotten through an election, but in 2014 we have a mid-term election as well.

JACKIE JUDD: So by oversight you’re talking about investigations…

MARY AGNES CAREY: Exactly, of the committees…

JACKIE JUDD: Possibly subpoenaing documents, witnesses, etc. Rich?

RICHARD E. COHEN: During the past two years, as your audience already knows, the Republicans said they wanted to repeal the Affordable Care Act and replace it with something else. They never really told us what that would be. And I think, number one, there’s going to be pressure on the Republicans since repeal will obviously not happen. What is it you want to replace it with? Number one. And number two, beyond Mary Agnes’ point about oversight, clearly there’s going to be all sorts of focus on the funding of the Affordable Care Act, and Congress will come into this with an excise that’s the power of the purse.

JACKIE JUDD: And the fiscal cliff conversations, negotiations begin soon. Does the ACA get in the bull’s-eye of some congressional negotiators to reduce spending?

MARY AGNES CAREY: Exactly. As part of a larger deal to reduce the federal deficit, one key question is: What changes might the president and our Democrats be open to on the Affordable Care Act? Would they, for example, scale back the subsidies? As they currently exist in the law, they go up to 400% of poverty — people may say that’s too generous. Could they scale back a tax on medical devices, which the medical device industry is screaming about is a job killer? Might the Democrats be willing to get rid of an advisory board in the health law that makes recommendations? Unless Congress passes something that’s different, those recommendations could go into effect. Democrats and Republicans dislike this. I think there’s all sorts of potential maneuvering. But if they do that, Republicans have to move on revenue, they have to go for higher taxes, which they have not wanted so far.

RICHARD E. COHEN: And for Republican desire to make, to reach a grand bargain, as part of the fiscal cliff negotiations, the Republicans have wanted much more than the Democrats to focus on all sorts of health care spending. Democrats, President Obama, have sought to avoid, to this point, bringing health care issues into the fiscal debate. It seems now that will happen, there will be more discussion of health care issues in order for all sides to have an opportunity to reach a grand bargain.

JACKIE JUDD: Let’s go back to the election results themselves. Did either of you spot changes in committees or chairmanships that could substantially alter the dynamics of that committee or how it operates?

RICHARD E. COHEN: Many people have referred to this as a status quo election. I think that that’s a little bit of a glib overstatement – although there’s something to be said, obviously Democrats keep control of the Senate, strengthening themselves … Republicans in the House. But inevitably in an election, members come and go. There’s going to be lots of freshmen. I think 70 or 80 freshmen in the House. Maybe 10 or 12 in the Senate.

And one committee that I think is worth paying attention to is the Senate Finance Committee. They play an important role on all tax and health care issues. It’s a committee that has prided itself over the years on its bipartisanship. It’s a committee where no members were defeated, but two Republicans and two Democrats retired. They include Olympia Snowe, clearly a centrist Republican, and Ken Conrad of North Dakota, centrist Democrat. Replacing them will be hard to do and probably it won’t happen. This will be an example, I think, of the polarization moving even into the Finance Committee.

JACKIE JUDD: And then on the House side, Congressman Pete Stark, a fixture of Congress, a liberal – he lost.

MARY AGNES CAREY: He lost to another Democrat. A new California election law allows the two top vote getters in the primary to go the general election. He was defeated by a 31-year-old Democrat, Eric Swalwell, who promised change and a new voice on Capitol Hill. Eric Swalwell had worked on Capitol Hill for Ellen Tauscher and decided, he went back home, went to law school, worked at home for a while in the district attorney’s office, and decided to go forward. He is very much a backer of the ACA. He dislikes changes to the Medicare program. So, I think, he’ll tow the Democratic line.

JACKIE JUDD: And Stark chaired the subcommittee on health, part of Ways and Means, so what does that mean? Well, he didn’t chair, sorry, he was the ranking member.

MARY AGNES CAREY: He’s chaired in the past, he’s the ranking member right now, so that position is up for grabs. Not only on the Democratic side, on the Republican side, the chairman on the Ways and Means health subcommittee, Wally Herger, did not run for re-election. So you’ll see movement there, on the Democratic side and the Republican side. When lawmakers come back to town next week, I think that will be part of the organizing of committees, there will be a lot of vying on both sides for that job.

RICHARD E. COHEN: I’ll add that a key question for House Democrats is: What does Democratic Leader Pelosi do? Well, there has been some speculation – not completely denied by other House Democrats – that she may choose to step down as Democratic leader. We’ll see.

JACKIE JUDD: Rich, did you see any trends emerging in the congressional and Senate races last night that could tell us something about how the reform law was viewed, how health care policy, how the Medicare issue – did you glean anything?

RICHARD E. COHEN: Well, House Republicans believe that they withstood a fierce Democratic attack on the House Republican budget, what’s been called the Paul Ryan budget. And Democrats said that Ryan’s selection to be Gov. Romney’s running mate was a game-changer. Democrats said they would be focusing even more on the problems that the Republican budget has created. Well, now the outcome from a Republican perspective is that they, in fact, dodged that bullet.

In fact, House Republicans are saying – and this will be significant going forward – that they’re reinforced, they’re bolstered in wanting to make significant changes in the Medicare program. Obviously, that’s something that Democrats can’t accept, so Medicare will be even more front-and-center and it’s going to be a tough issue to find common ground.

JACKIE JUDD: Paul Ryan, of course, isn’t going to be the vice president, but he is going to be a very important part of the Republican Party, as it moves forward. And he will be a person to watch.

RICHARD E. COHEN: No question. To the extent he remains in Congress and wants to be a player, he’s front-and-center as a negotiator in these fiscal talks.

JACKIE JUDD: Okay, thank you both so much. I know we’re going to be talking a lot more about this as we go on. Thank you.